BACKGROUND: The effectiveness
of operating room headgear in preventing airborne contamination has been called into question. We
hypothesized that bouffant style hats would be as effective in preventing bacterial and particulate
contamination in the operating room compared with disposable or cloth skull caps, and bouffant
style hats would have similar permeability, particle penetration, and porosity compared
with skull caps. STUDY DESIGN: Disposable
bouffant and skull cap hats and newly laundered cloth skull caps were tested. A mock surgical procedure was used in
a dynamic operating room environment. Airborne particulate and microbial contaminants were
sampled. Hat fabric was tested for permeability,particle transmission, and pore
sizes. RESULTS: No significant
differences were observed between disposable bouffant and disposable skullcaps with regard to particle or
actively sampled microbial contamination. However, when compared with disposable skull
caps, disposable bouffant hats did have significantly higher microbial shed at the sterile
field, as measured by passive settle plate analysis (p < 0.05). When compared with cloth skull
caps, disposable bouffants yielded higher levels of 0.5micron and 1.0micron particles and
significantly higher microbial shed detected with passive analysis.Fabric assessment determined that
disposable bouffant hats had larger average and maximum pore sizes compared with
cloth skull caps, and were significantly more permeable than either disposable or cloth
skull caps. CONCLUSIONS: Disposable
bouffant hats had greater permeability, penetration, and greater microbial
shed, as assessed by passive microbial
analysis compared with disposable skull caps. When compared with cloth skull caps, disposable
bouffants yielded greater permeability, greater particulate contamination, and greater passive
microbial shed. Disposable style bouffant hats should not be considered superior to skull
caps in preventing airborne contamination in the operating room. (J Am Coll Surg 2017;225:573e581.
2017 by the American College of Surgeons. Published by Elsevier Inc. All rights
reserved.)